Take it to the bank, breast milk is best
Aug 25, 2005

The Globe and Mail

Earlier this month, a California company launched the world's first commercial breast-milk bank.

Prolacta Bioscience plans to obtain breast milk from lactating mothers around the United States, pasteurize it, and sell it to hospitals for the treatment of low-birth-weight babies.

"Human breast milk has 100,000 different components and we only really know what a few thousand of them are and what they do," Elena Medo, chief executive officer of Prolacta, said at the launch of the venture. "It's an enormous area of discovery. I'm sure there's a reason for every one of those components and I'd like to know half of them in my lifetime."

Dr. Medo, a scientist and entrepreneur, is saying what mothers have been saying for millenniums: Breast is best.

The tragedy of this story is that a company is commercializing breast milk at a time when Canada has virtually abandoned its very successful network of not-for-profit breast-milk banks.

Breast milk's superiority over formula is particularly true for babies of low birth weight, who are susceptible to infections and a host of other health problems. When mothers cannot produce breast milk themselves -- often the case when a baby is born very prematurely -- they turn to donors. Research has shown that donor breast milk is particularly effective in preventing necrotizing enterocolitis, a condition in which the bowel becomes inflamed, with potentially fatal results.

There is now only a single human-milk bank in this country, at Women's and Children's Hospital in Vancouver, and it seems to be under constant threat of closing. The Vancouver breast-milk bank is a modest affair, but an invaluable service. Last year, it provided pasteurized breast milk to 255 babies. Some needed the service for only a couple of days; others were supplied for months.

Breastfed babies -- premature and otherwise -- are significantly less likely to die in the first year of life than those who are formula fed, even in prosperous countries like Canada. Researchers have found that breastfed babies are less likely to die of sudden infant death syndrome, and less likely to get ear infections, allergies and colds. Later in life, they are less likely to develop serious conditions like Type 1 diabetes, rheumatoid arthritis, Crohn's disease, and breast and ovarian cancer.

The Public Health Agency of Canada, the Canadian Paediatric Society and the World Health Organization all recommend that babies be fed breast milk exclusively for the first six months of life, saying that it "provides all the nutrients, growth factors and immunological factors a healthy term infant needs." The evidence also favours exclusive breastfeeding of premature babies.

But support for breast-milk banks has waned because of the fear of disease transmission, particularly HIV-AIDS. Proponents argue, however, that the demonstrated -- and not yet discovered -- benefits of breast milk far outweigh the theoretical risks of disease. Besides, donor breast milk is pasteurized and donors are subject to rigorous screening, including blood tests.

The donors, it needs to be noted, are an extraordinary group. Mothers themselves (obviously), they express and store their milk according to rigorous standards, and do so altruistically. Breast-milk donors are not paid.

Donors are asked to provide a minimum donation of 100 ounces of breast milk but some donate much more. (Because screening is so expensive, small donations are not cost-effective.)

One of the reasons milk banks foundered in Canada was that too few health professionals knew about them. Unfortunately, breast milk is not promoted the way formula is promoted.

But the larger problem was and is lack of institutional support, one that bedevils the promotion of breastfeeding more generally.

In Canada, 85 per cent of new moms breastfeed newborns, but by six months, fewer than half still do so. According to Statistics Canada, a mere one in six mothers breastfeed exclusively for the first six months, meaning that the vast majority of women are ignoring public-health recommendations.

Women want to do what is best for their children. But it is difficult to do so with a total absence of support, in an environment where breastfeeding clinics are being shut down, where lactation consulting is considered a frill rather than a core service, and where breastfeeding in public is frowned upon. (Consider recent comments by ABC News star Barbara Walters, who said she was uncomfortable when a woman breastfed on a plane, and the regular news reports about mothers who are harassed for feeding babies in malls and other public spaces.)

It is not enough for public-health officials to support breastfeeding in theory. They need to do so in practice. And that begins with the promotion and financial support of breast-milk banks.

If nothing else, the commercial venture launched by Prolacta should serve as a potent reminder of the value of breast-milk banking, and of breastfeeding more generally.